Prognostic value of right ventricular glucose metabolism activity by 18F-FDG PET/CT in patients with ischemic heart failure

Introduction: To investigate the clinical diagnosis, treatment and prognostic value of right ventricular imaging in ¹⁸F-FDG PET/CT myocardial metabolic imaging in patients with ischemic heart failure (IHF).

Methods: Patients with coronary artery disease and severe IHF (LVEF_G-MPI≤35%), who underwent gated ^99mTc-MIBI SPECT myocardial perfusion imaging (G-MPI) and ¹⁸F-FDG PET/CT myocardial metabolic imaging, were enrolled between April 2016 to June 2019. According to the size of right ventricle (RV) and the ¹⁸F-FDG uptake activity of right ventricle, visual score analysis was performed. The higher the total score, the greater degree of abnormality in the right ventricle. Patients were then divided into three groups based on RV visual scores from lowest to highest and were followed up. Cardiac death was the only endpoint. Cox regression analysis identified the independent factors for predicting cardiac death. Survival curves were obtained by the Kaplan-Meier method and compared with the log-rank test.

Results: 365[316 (86.6%) men, age (58.4±10.1) years] consecutive patients were initially included. Only 12.1% (n=44) had increased RV uptake. Compared with IHF patients without increased RV uptake, those with increased RV uptake were younger (54.3±7.9 vs. 59.3±19.1, P<0.001) and had lower BMI (24.2±2.7 vs. 25.3±3.6, P=0.002). After propensity score matching of 365 patients, 194 IHF patients were finally included [179 (92.3%) men, age (55.0 ± 9.4) years] for survival analysis. During follow-up [52.8 (44.2, 61.6) months], 39 (20.1%) cardiac deaths were observed. The survival rate in high RV score group was significantly lower than that in low RV score group (P=0.017). Cox multivariate regression analysis showed that age (HR=1.045, 95%CI: 1.005-1.087, P=0.028), revascularization (HR=0.437,95%CI: 0.196-0.975, P=0.043), LVESVI (HR=1.009,95%CI: 1.000-1.017, P=0.042), the RV score tertile (HR=1.588, 95%CI: 1.099-2.296, P=0.014) were independent factors for predicting cardiac death.

Conclusions: IHF patients with RV enlargement and higher ¹⁸F-FDG activity were associated with worse outcome. It would be helpful for risk stratification in patients with IHF.

Funding National Natural Science Foundation of China (82171994); Beijing Municipal Administration of Hospitals (ZYLX202110); Beijing Natural Science Foundation (7232040)

• Download figure
• Open in new tab
• Download powerpoint